Healthcare Provider Details

I. General information

NPI: 1700975117
Provider Name (Legal Business Name): MR. MICHAEL JASON ECHEVARRIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 S CASS AVE STE E
WESTMONT IL
60559-3275
US

IV. Provider business mailing address

6601 S CASS AVE STE E
WESTMONT IL
60559-3275
US

V. Phone/Fax

Practice location:
  • Phone: 630-725-0532
  • Fax: 630-725-0534
Mailing address:
  • Phone: 630-725-0532
  • Fax: 630-725-0534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1010525
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: